Provider Demographics
NPI:1376995258
Name:MILLIS, LOUDENA
Entity Type:Individual
Prefix:MISS
First Name:LOUDENA
Middle Name:
Last Name:MILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3009
Mailing Address - Country:US
Mailing Address - Phone:617-889-8779
Mailing Address - Fax:
Practice Address - Street 1:175 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3009
Practice Address - Country:US
Practice Address - Phone:617-889-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)